RSD: What is Reflex Sympathetic Dystrophy?

Everyday you face the same relentless pain. Moments of relief are few and far between. It takes everything you have to fight through the pain and depression and keep going. What causes this chronic pain? It is Reflex Sympathetic Disorder (RSD) and the battle has only just begun.

WHAT IS RSD?

Reflex Sympathetic Dystrophy is a severe condition that causes chronic pain. It usually involves a leg or arm. It is a chronic, painful and progressive neurological condition that affects skin, muscles, joints and bones. It is called many other names including algodystrophy, causalgia, shoulder-hand syndrome, Sudeck’s atrophy and transient osteoporosis. The name was officially changed to Complex Regional Pain Syndrome in 1995. This name change has not been accepted universally.

RSD is characterized by severe and relentless pain that affects between 200,000 and 1.2 million Americans. RSD is a malfunction of the nervous system that causes the nerves to misfire, sending constant pain signals to the brain.

RSD was first documented in the 19th century by physicians who were treating Civil War veterans whose pain continued well after their wounds had healed. Over the years the syndrome was classified as one of the peripheral neuropathies. It is now classified as a chronic pain syndrome.

There are three types of RSD. Type one is characterized by severe, burning pain at the site of the injury. Other symptoms that can occur are muscle spasm, joint stiffness, restricted mobility, rapid hair and nail growth and vasospasm which is a constriction of the blood vessels, that affects color and temperature of the skin.

Type two is characterized by more intense pain. Swelling spreads, hair growth stops, nails become cracked, grooved, brittle and spotty. Osteoporosis becomes severe and diffuse, joints thicken and muscles atrophy.

Type three is characterized by irreversible changes in the skin and bones. The pain becomes constant and intense and may involve the entire limb. There is marked muscle atrophy, mobility is severely limited and the flexor tendon contractions (contractions of the muscles and tendons that flex the joints). Occasionally the limb is displaced from its normal position and marked bone softening is more dispersed.

THE DIAGNOSIS

RSD is often misdiagnosed because it is not understood. It is often misdiagnosed as a migraine, bursitis of the shoulder or hip, frozen shoulder, phantom pain, migratory osteolysis, thoracic outlet syndrome, myofascial injury, Raynaud’s phenomenon, rotator cuff injury, transient regional osteoporosis, shoulder-hand syndrome, ligamentous injury, thalamic pain, aseptic necrosis of hip and TMJ disease.

Diagnosis is complicated by the fact that some patients improve without treatment. Delays in diagnosis and treatment for this syndrome can result in severe physical and psychological problems. Diagnosis is usually made when at least three of the following symptoms are present: pain and tenderness, signs of changed blood flow (either increased or decreased), swelling with joint stiffness or skin changes.

Symptoms usually occur near the site of an injury, either major or minor, and include burning pain, muscle spasms, local swelling, increased sweating, softening of bones, joint tenderness or stiffness, restricted or painful movement and changes in the nails and skin. One of the most visible signs of RSD is the skin near the site of injury is warm, shiny and red that later becomes cool and bluish.

The exact causes of RSD are still unknown. RSD appears to involve the complex interaction of the sensor, motor and autonomic nervous systems and the immune system. It is possible that the brain and spinal cord (central nervous system) control over these various processes is somehow changed as a result of an injury.

Causes associated with the onset of RSD include cerebral lesions, heart disease or heart attack, infection, paralysis on one side of the body (hemiplegia), radiation therapy, repetitive motion disorder such as carpal tunnel syndrome, spinal cord disorders, surgery and a trauma such as a bone fracture, gunshot and shrapnel wounds. No direct cause can be found in 10% to 20% of cases.

TREATMENT

Early diagnosis along with treatment are very important. A variety of drugs are used to treat RSD that include corticosteroids, vasodilators and alpha- or beta-adrenergic-blocking compounds. Physical therapy and TENS are also used to treat RSD. TENS (transcutaneous electrical nerve stimulation) is a procedure in which brief pulses of electricity are applied to nerve endings under the skin. This helps to relieve the chronic pain. Although surgery is an option to relive the pain it is not recommended. Surgery involves cutting the nerve or nerves which destroys the pain almost instantly. Unfortunetly this may also destroy other sensations too.

Although RSD is poorly understood it is not a rare disorder. RSD affects millions of people. There is no known way to prevent RSD because the cause is not clear. If you or someone you know suffers from RSD don’t give up the fight. Although your body may ache, don’t let your spirit break.

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